Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 25.00: Perc cardiovasc proc w drug-eluting stent w/o MCC

Facility

$37,475.00

Service Code	MSDRG 247
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$37,475.00
Rate for Payer: United Healthcare All Other HMO	$37,475.00
Rate for Payer: United Healthcare HMO Rider	$28,460.00
Rate for Payer: United Healthcare Select/Navigate/Core	$26,075.00

MS-DRG 25.00: Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents

Facility

$38,180.00

Service Code	MSDRG 248
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$38,180.00
Rate for Payer: United Healthcare All Other HMO	$38,180.00
Rate for Payer: United Healthcare HMO Rider	$29,001.00
Rate for Payer: United Healthcare Select/Navigate/Core	$26,569.00

MS-DRG 25.00: Perc cardiovasc proc w non-drug-eluting stent w/o MCC

Facility

$35,065.00

Service Code	MSDRG 249
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$35,065.00
Rate for Payer: United Healthcare All Other HMO	$35,065.00
Rate for Payer: United Healthcare HMO Rider	$17,320.00
Rate for Payer: United Healthcare Select/Navigate/Core	$15,867.00

MS-DRG 25.00: Perc cardiovasc proc w/o coronary artery stent or AMI w MCC

Facility

$117,977.71

Service Code	MSDRG 250
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$117,977.71
Rate for Payer: United Healthcare All Other Commercial	$32,556.00
Rate for Payer: United Healthcare All Other HMO	$32,556.00
Rate for Payer: United Healthcare HMO Rider	$27,066.00
Rate for Payer: United Healthcare Select/Navigate/Core	$24,796.00

MS-DRG 25.00: Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC

Facility

$105,769.26

Service Code	MSDRG 251
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$105,769.26
Rate for Payer: United Healthcare All Other Commercial	$41,406.00
Rate for Payer: United Healthcare All Other HMO	$41,406.00
Rate for Payer: United Healthcare HMO Rider	$22,531.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,641.00

MS-DRG 25.00: Permanent cardiac pacemaker implant w CC

Facility

$117,062.07

Service Code	MSDRG 243
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$117,062.07
Rate for Payer: United Healthcare All Other Commercial	$29,923.00
Rate for Payer: United Healthcare All Other HMO	$29,923.00
Rate for Payer: United Healthcare HMO Rider	$24,583.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,521.00

MS-DRG 25.00: Permanent cardiac pacemaker implant w MCC

Facility

$135,905.30

Service Code	MSDRG 242
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$135,905.30
Rate for Payer: United Healthcare All Other Commercial	$38,262.00
Rate for Payer: United Healthcare All Other HMO	$38,262.00
Rate for Payer: United Healthcare HMO Rider	$36,089.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,062.00

MS-DRG 25.00: Permanent cardiac pacemaker implant w/o CC/MCC

Facility

$111,323.39

Service Code	MSDRG 244
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$111,323.39
Rate for Payer: United Healthcare All Other Commercial	$25,087.00
Rate for Payer: United Healthcare All Other HMO	$25,087.00
Rate for Payer: United Healthcare HMO Rider	$20,612.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,884.00

MS-DRG 25.00: Prostatectomy w/o CC/MCC

Facility

$98,878.96

Service Code	MSDRG 667
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$98,878.96
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 25.00: Revision of hip or knee replacement w CC

Facility

$141,828.52

Service Code	MSDRG 467
Min. Negotiated Rate	$32,499.00
Max. Negotiated Rate	$141,828.52
Rate for Payer: United Healthcare All Other Commercial	$36,468.00
Rate for Payer: United Healthcare All Other HMO	$36,468.00
Rate for Payer: United Healthcare HMO Rider	$35,474.00
Rate for Payer: United Healthcare Select/Navigate/Core	$32,499.00

MS-DRG 25.00: Revision of hip or knee replacement w MCC

Facility

$171,618.53

Service Code	MSDRG 466
Min. Negotiated Rate	$39,477.00
Max. Negotiated Rate	$171,618.53
Rate for Payer: United Healthcare All Other Commercial	$39,477.00
Rate for Payer: United Healthcare All Other HMO	$39,477.00
Rate for Payer: United Healthcare HMO Rider	$45,640.00
Rate for Payer: United Healthcare Select/Navigate/Core	$41,813.00

MS-DRG 25.00: Revision of hip or knee replacement w/o CC/MCC

Facility

$128,012.41

Service Code	MSDRG 468
Min. Negotiated Rate	$28,986.00
Max. Negotiated Rate	$128,012.41
Rate for Payer: United Healthcare All Other Commercial	$39,477.00
Rate for Payer: United Healthcare All Other HMO	$39,477.00
Rate for Payer: United Healthcare HMO Rider	$31,639.00
Rate for Payer: United Healthcare Select/Navigate/Core	$28,986.00

MS-DRG 25.00: Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC

Facility

$185,063.77

Service Code	MSDRG 457
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$185,063.77
Rate for Payer: United Healthcare All Other Commercial	$90,575.00
Rate for Payer: United Healthcare All Other HMO	$90,575.00
Rate for Payer: United Healthcare HMO Rider	$62,293.00
Rate for Payer: United Healthcare Select/Navigate/Core	$57,072.00

MS-DRG 25.00: Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC

Facility

$254,757.47

Service Code	MSDRG 456
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$254,757.47
Rate for Payer: United Healthcare All Other Commercial	$112,148.00
Rate for Payer: United Healthcare All Other HMO	$112,148.00
Rate for Payer: United Healthcare HMO Rider	$75,636.00
Rate for Payer: United Healthcare Select/Navigate/Core	$69,294.00

MS-DRG 25.00: Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC

Facility

$153,291.68

Service Code	MSDRG 458
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$153,291.68
Rate for Payer: United Healthcare All Other Commercial	$81,933.00
Rate for Payer: United Healthcare All Other HMO	$81,933.00
Rate for Payer: United Healthcare HMO Rider	$53,969.00
Rate for Payer: United Healthcare Select/Navigate/Core	$49,445.00

MS-DRG 25.00: Spinal fusion except cervical w MCC

Facility

$76,782.00

Service Code	MSDRG 459
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$76,782.00
Rate for Payer: United Healthcare All Other Commercial	$76,782.00
Rate for Payer: United Healthcare All Other HMO	$76,782.00
Rate for Payer: United Healthcare HMO Rider	$52,096.00
Rate for Payer: United Healthcare Select/Navigate/Core	$47,726.00

MS-DRG 25.00: Spinal fusion except cervical w/o MCC

Facility

$81,808.00

Service Code	MSDRG 460
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$81,808.00
Rate for Payer: United Healthcare All Other Commercial	$81,808.00
Rate for Payer: United Healthcare All Other HMO	$81,808.00
Rate for Payer: United Healthcare HMO Rider	$32,713.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,970.00

MS-DRG 25.00: Spinal procedures w CC or spinal neurostimulators

Facility

$139,787.87

Service Code	MSDRG 029
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$139,787.87
Rate for Payer: United Healthcare All Other Commercial	$76,644.00
Rate for Payer: United Healthcare All Other HMO	$76,644.00
Rate for Payer: United Healthcare HMO Rider	$36,551.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,485.00

MS-DRG 25.00: Spinal procedures w MCC

Facility

$185,865.85

Service Code	MSDRG 028
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$185,865.85
Rate for Payer: United Healthcare All Other Commercial	$58,958.00
Rate for Payer: United Healthcare All Other HMO	$58,958.00
Rate for Payer: United Healthcare HMO Rider	$54,569.00
Rate for Payer: United Healthcare Select/Navigate/Core	$49,994.00

MS-DRG 25.00: Spinal procedures w/o CC/MCC

Facility

$118,203.06

Service Code	MSDRG 030
Min. Negotiated Rate	$20,798.00
Max. Negotiated Rate	$118,203.06
Rate for Payer: United Healthcare All Other Commercial	$58,958.00
Rate for Payer: United Healthcare All Other HMO	$58,958.00
Rate for Payer: United Healthcare HMO Rider	$22,701.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,798.00

MS-DRG 25.00: Uterine & adnexa proc for non-malignancy w CC/MCC

Facility

$111,807.81

Service Code	MSDRG 742
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$111,807.81
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 25.00: Uterine & adnexa proc for non-malignancy w/o CC/MCC

Facility

$101,265.63

Service Code	MSDRG 743
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$101,265.63
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 25.00: Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC

Facility

$104,555.50

Service Code	MSDRG 741
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$104,555.50
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 25.00: Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC

Facility

$134,519.42

Service Code	MSDRG 464
Min. Negotiated Rate	$34,033.00
Max. Negotiated Rate	$134,519.42
Rate for Payer: United Healthcare All Other Commercial	$112,353.00
Rate for Payer: United Healthcare All Other HMO	$112,353.00
Rate for Payer: United Healthcare HMO Rider	$37,147.00
Rate for Payer: United Healthcare Select/Navigate/Core	$34,033.00

MS-DRG 25.00: Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w MCC

Facility

$180,386.25

Service Code	MSDRG 463
Min. Negotiated Rate	$46,778.00
Max. Negotiated Rate	$180,386.25
Rate for Payer: United Healthcare All Other Commercial	$112,353.00
Rate for Payer: United Healthcare All Other HMO	$112,353.00
Rate for Payer: United Healthcare HMO Rider	$51,058.00
Rate for Payer: United Healthcare Select/Navigate/Core	$46,778.00

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All Charges